Acousting imaging catheters and the like

ABSTRACT

Acoustic imaging balloon catheters formed by a disposable liquid-confining sheath supporting a high fidelity, flexible drive shaft which carries on its end an ultrasound transducer and includes an inflatable dilatation balloon. The shaft and transducer rotate with sufficient speed and fidelity to produce real time images on a T.V. screen. In preferred embodiments, special features that contribute to the high fidelity of the drive shaft include the particular multi-filar construction of concentric, oppositely wound, interfering coils, a pre-loaded torque condition on the coils enhancing their interfering contact, and dynamic loading of the distal end of the probe, preferably with viscous drag. The coil rotating in the presence of liquid in the sheath is used to produce a desirable pressure in the region of the transducer. Numerous selectable catheter sheaths are shown including a sheath with an integral acoustically-transparent window, sheaths with end extensions that aid in positioning, a liquid injection-producing sheath, a sheath having its window section under tension employing an axially loaded bearing, a sheath carrying a dilatation or positioning balloon over the transducer, a sheath carrying a distal rotating surgical tool and a sheath used in conjunction with a side-viewing trocar.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.07/570,319, filed Aug. 21, 1990 by Robert J. Crowley et al., which is acontinuation-in-part of U.S. application Ser. No. 07/171,039, now U.S.Pat. No. 4,951,677, filed Mar. 21, 1988 by Robert J. Crowley et al. Theentire disclosure of U.S. application Ser. No. 7/570,319 is herebyincorporated herein by reference.

BACKGROUND OF THE INVENTION

This invention relates to acoustic imaging catheters employing arotating transducer.

It has long been recognized that acoustic imaging by use of internalprobes has potential use in visualizing conditions of a body.

Wider effective use of acoustic imaging would occur, especially in thevascular system, if such a system could be considerably smaller, havegood image fidelity, and be simple, inexpensive and dependable.

SUMMARY OF THE INVENTION

An acoustic catheter is provided comprising an elongated, flexible,liquid-confining catheter sheath and an elongated, flexible ultrasonicprobe disposed within and rotatably supported by a lumen of the sheath,the ultrasonic probe comprising a transducer supported on the end of anelongated coil-form drive shaft, a distal portion of the catheter sheaththat corresponds with the position of the transducer being substantiallytransparent to acoustical energy transmitted and received by thetransducer and the probe, and the sheath being cooperatively constructedand arranged to enable removal and replacement of the sheath in adisposable manner.

In preferred embodiments, the sheath includes a catheter sheath having adistal projection supported by the catheter sheath and extendingdistally from the position of the transducer; the distal projectionincludes an elongated guide means of smaller diameter and greaterflexibility than the catheter sheath; alternatively, the distalprojection includes means to introduce contrast medium or other fluiddistal of the probe.

In preferred embodiments, the portion of the catheter sheath which issubstantially transparent to acoustical energy is integral (i.e. withouta joint) with a proximal portion of the catheter sheath; thesubstantially transparent portion of the catheter sheath has a thinnerwall than said proximal portion; and the catheter sheath includes aresinous substance.

Another preferred embodiment includes the elongated probe or catheterdescribed above, in combination with a hollow trocar adapted to receivethe probe or catheter, the trocar having a side-facing window adapted toregister with the transducer enabling the transducer to form acousticimages of tissue into which the trocar has been forced.

Other aspects, features and advantages of the invention will be apparentfrom the following description of the preferred embodiments and from theclaims.

The invention enables the achievement of micro-acoustic, close-upimaging, via catheter, of restricted regions of the body that aredifficult of access.

DETAILED DESCRIPTION

The figures will first briefly be described,

Drawings

FIG. 1 is a schematic diagram of a preferred system showing use of anacoustic catheter according to the invention;

FIG. 2 is a side view of a disposable catheter sheath for the acousticcatheter;

FIG. 3 is a longitudinal, partially cut away view of the distal end ofthe rotating assembly of the acoustic catheter;

FIG. 4 is a longitudinal, cross-sectional view of the distal end of theassembled acoustic catheter;

FIG. 5 is a longitudinal sectional view of the transducer element of thecatheter on a greatly magnified scale;

FIG. 6 is a diagrammatic representation of sound waves emanating fromthe acoustic lens of the catheter;

FIGS. 7-7d illustrate steps in filling the sheath and assembling theacoustic catheter of the figures, the syringe portions of the figuresbeing on a reduced scale;

FIG. 8 is a cross-sectional view of the motor-connector assembly towhich the catheter is connected while FIG. 8a is a view on an enlargedscale of a portion of FIG. 8;

FIGS. 9, 10 and 11 are graphical representations of torque in relationto angular deflection.

FIG. 12 is a block diagram of the electronic components useful with theacoustical catheter of the invention;

FIGS. 13 and 13a illustrate an acoustic imaging catheter sheath having adistal floppy guide wire;

FIGS. 14 and 14a illustrate an acoustic imaging catheter sheath having adistal anchoring needle;

FIG. 15 illustrates an acoustic imaging catheter sheath having a distalcatheter extension beyond the transducer;

FIG. 16 illustrates a combination balloon dilatation/acoustic imagingcatheter sheath while FIGS. 16a, 16b and 16c illustrate stages ofinflation of the balloon;

FIG. 17 is a view of a preferred embodiment of an acoustic imagingballoon angioplasty catheter.

FIG. 17a is an expanded view of the distal end of the balloon catheter.

FIG. 17b is a partial cross sectional view taken along line 17B--17B inFIG. 17a; FIG. 17c is an expanded view of FIG. 17b.

FIG. 17d is an expanded view of the proximal end of the cathetercoupling, in partial cross-section.

FIG. 18-18e illustrate the use of an acoustic imaging balloonangioplasty catheter in a blood vessel.

FIG. 19 is a view of an alternative embodiment of an acoustic imagingdilatation balloon catheter.

FIGS. 20-20b are views of alternative embodiments of acoustic imagingdilatation balloon catheters enabling relative axial positioning of thetransducer and the balloon.

FIGS. 21-21b are views of alternative embodiments of an acoustic imagingballoon catheter, including multiple balloons.

FIG. 22 and 22a illustrate an acoustic catheter sheath adapted forguidance by a guide wire;

FIG. 23 illustrates an acoustic catheter sheath which is deflectable byactuation from the proximal end;

FIGS. 24 and 24a illustrate an acoustic catheter sheath capable ofinjection of a fluid;

FIGS. 25-25c illustrate the combination of an acoustic catheter with atrocar;

FIG. 26 illustrates an integrally formed acoustic catheter sheath;

FIG. 27 illustrates an acoustic catheter sheath having an integralflexible distal extension;

FIGS. 28 and 28a illustrate a thin-walled acoustic catheter sheathresiding under tension during use;

FIGS. 29 and 29a illustrate an acoustic catheter capable of driving adistal tool; and

FIGS. 30-30c illustrate various positions of an acoustic imagingcatheter during imaging of a heart valve; and

FIG. 31 illustrates an acoustic catheter sheath having an integrallyformed acoustic window.

GENERAL STRUCTURE

Referring to FIG. 1, a micro-acoustic imaging catheter 6 according tothe invention is driven and monitored by a control system 8. Thecatheter is comprised of a disposable catheter sheath 12 (FIGS. 2 and 4)having a sound-transparent distal window 24 provided by dome element 25(FIG. 4), in which is disposed a miniature, rotatable ultrasonictransducer 10 (FIGS. 3 and 4) driven by a special, high fidelityflexible drive shaft 18. A relatively rigid connector 11 is joined tothe proximal end of the main body of the catheter sheath, adapted to bejoined to a mating connector of drive and control system 8.

The catheter is adapted to be positioned in the body by standardcatheter procedures for example within a blood vessel or the heart byguiding the flexible catheter through various blood vessels along acircuitous path, starting, for example, by percutaneous introductionthrough an introducer sheath 13 disposed in a perforation of the femoralartery 15.

Referring to FIG. 2, disposable catheter sheath 12 is a long tube,extruded from standard catheter materials, here nylon, e.g. with outerdiameter, D, of 2 mm, wall thickness of 0.25 mm and length of 1 meter.Dome element 25, connected to the distal end of the tube, is asemi-spherically-ended cylindrical transducer cover constructed ofmaterial which is transparent to sound waves, here high impactpolystyrene. This dome element has a thickness of approximately 0.125 mmand a length E of about 8 mm. For purposes described later herein,catheter sheath 12 in its distal region preferably tapers down overregion R as shown in FIG. 4 to a narrowed diameter D' at its distal end,achieved by controlled heating and drawing of this portion of theoriginal tube from which the sheath is formed. Catheter sheath 12 andacoustically transparent dome element 25 are adhesively bonded together.

Referring to FIGS. 3 and 4, the drive shaft assembly 18 is formed of apair of closely wound multi-filar coils 26, 28 wound in opposite helicaldirections. These coils are each formed of four circular cross-sectionalwires, one of which, 30, is shown by shading. Coils 26, 28 are solderedtogether at both the distal and proximal ends of the assembly ininterference contact, here under rotational pre-stress. By alsoproviding a pitch angle of greater than about 20°, a substantial part ofthe stress applied to the wire filaments of the coil is compression ortension in the direction of the axis of the filaments, with attendantreduction of bending tendencies that can affect fidelity of movement.There is also provision to apply a torsional load to the distal end ofthe assembly to cause the drive shaft to operate in the torsionallystiff region of its torsional spring constant curve, achieved by viscousdrag applied to the rotating assembly by liquid filling the narroweddistal end of the catheter sheath (FIG. 4). Such loading, together withinitial tight association of the closely wound filaments in theconcentric coils, provides the assembly with a particularly hightorsional spring constant when twisted in a predetermined direction.Thus, despite its lateral flexibility, needed for negotiating tortuouspassages, the assembly provides such a torsionally stiff and accuratedrive shaft that rotary position information for the distal end can,with considerable accuracy, be derived from measurement at the proximalend of the drive shaft, enabling high quality real-time images to beproduced. (Further description of the coils of the drive shaft and theircondition of operation is provided below.)

Coaxial cable 32 within coils 26, 28 has low power loss and comprises anouter insulator layer 34, a braided shield 36, a second insulator layer38, and a center conductor 40. Shield 36 and center conductor 40 areelectrically connected by wires 42, 44 (FIG. 5) to piezoelectric crystal46 and electrically conductive, acoustical backing 48 respectively, ofthe transducer. Helical coils 26, 28, especially when covered with ahighly conductive metal layer, act as an additional electric shieldaround cable 32.

Transducer crystal 46 is formed in known manner of one of a family ofceramic materials, such as barium titanates, lead zirconate titanates,lead metaniobates, and PVDFs, that is capable of transforming pressuredistortions on its surface to electrical voltages and vice versa.Transducer assembly 10 is further provided with an acoustic lens 52. Theradius of curvature B of lens surface 52 is greater than about 2.5 mm,chosen to provide focus over the range f (FIG. 6) between about 2 to 7mm. The lens is positioned at an acute angle to the longitudinal axis ofthe catheter so that, during rotation, it scans a conical surface fromthe transducing tip, the angle preferably being between 10° and 80°,e.g., 30°. Transducer backing 48 is acoustically matched to thetransducer element to improve axial resolution.

The transducer assembly 10 is supported at the distal end of the driveshaft by a tubular sleeve 29 which is telescopically received over adistal extension of the inner coil 28, as shown in FIG. 3.

Referring again to FIG. 4, the length, E, of dome element 25 issufficient to provide headroom F for longitudinal movement of transducer10 within the dome element as catheter sheath 12 and coils 26, 28 aretwisted along the blood vessels of the body. In the untwisted state,transducer 10 is a distance F, about 2 to 3 mm, from the internal endsurface of the dome element 25. The dome element, along with cathetersheath 12 is adapted to be filled with lubricating andsound-transmitting fluid.

FIGS. 7-7b show the filling procedure used to prepare ultrasoundcatheter sheath 12 (or any of the other interchangeable sheaths, seeFIGS. 13-26) for attachment to the ultrasound imaging drive shaft andtransducer assembly. A sterile, flexible filling tube 17 attached to asyringe 19 is filled with sterile water. This filling catheter isinserted into the ultrasound catheter sheath 12, all the way to thedistal tip. The water is then injected until it completely fills and theexcess spills out of the ultrasound catheter while held in a verticalposition; see FIG. 7a. This expels air from the catheter which couldimpair good acoustic imaging. Continued pressure on the plunger of thesyringe causes the flexible tube 17 to be pushed upward, out of catheter12, FIG. 7b, leaving no air gaps behind. This eliminates the necessityto carefully withdraw the flexible filling tube at a controlled ratewhich could be subject to error. A holding bracket 21 is used to holdthe catheter vertical during this procedure.

After the catheter sheath 12 is filled, the acoustic transducer 10 andshaft 18 are inserted, displacing water from the sheath 12, until theinstalled position, FIG. 7d, is achieved.

FIGS. 8 and 8a (and FIG. 1, diagrammatically) show the interconnectionarrangement for a connector 7 at proximal end of the acoustic catheterwith connector 16 of the driving motor 20, and the path of the electricwires through the center shaft 43 of the driving motor. The center shaftand connector 16 rotate together, as do the wires that pass through thehollow motor shaft. The latter connect to a rotating electrical joint27, which is held stationary at the back end and is connected tostationary coaxial cable 45 through a suitable connector such as acommon BNC type. The enlarged view shows how the motor connector 16 andthe driveshaft connector 7 mate when the two assemblies are pushedtogether, thereby making both electrical and mechanical contact. Thecatheter connector 7 is held in position by an ordinary ball bearingwhich provides a thrusting surface for the rotating connector 16 anddriveshaft 18 while allowing free rotation. The disposable cathetersheath 12 includes an inexpensive, relatively rigid hollow bushing 11 ofcylindrical construction that allows it to be slid into and held bymeans of a set screw in the housing that captures the non-disposablebearing, connector, and driveshaft 18. Drive shaft coil assembly 18,thus attached at its proximal end to connector 16 of drive motor 20,rotates transducer 10 at speeds of about 1800 rpm. The transducer 10 iselectrically connected by coaxial cable 32 extending through coilassembly 18 and via the cable through the motor to the proximalelectronic components 22 which send, receive and interpret signals fromthe transducer. Components 22 include a cathode ray tube 23, electroniccontrols for the rotary repetition rate, and standard ultrasonic imagingequipment; and see FIG. 12. A rotation detector, in the form of a shaftencoder shown diagrammatically at 19, detects the instantaneousrotational position of this proximal rotating assembly and applies thatpositional information to components 22, e.g., for use in producing thescan image.

By thus depending upon the position of proximal components to representthe instantaneous rotational position of the distal components, therotational fidelity of the drive shaft is of great importance to thisembodiment.

Manufacture and Assembly of the Drive Shaft

Referring to FIGS. 3 and 4, coils 26, 28 are each manufactured bywinding four round cross-section stainless steel wires of size about 0.2mm, so that D_(o) is about 1.3 mm, D_(i) is about 0.9 mm, d_(o) is about0.9 mm and d_(i) is about 0.5 mm. The coils are closely wound with apitch angle α_(o) and α_(i) where α_(o) is smaller than α_(i), e.g.,221/2° and 31°, respectively. (Flat wires having a cross-sectional depthof about 0.1 mm may also be used.) The pitch angles are chosen toeliminate clearances 60 between the wires and to apply a substantialpart of the stress in either tension or compression along the axis ofthe wire filaments. The coils, connected at their ends, are adapted tobe turned in the direction tending to make outer coil 26 smaller indiameter, and inner coil 28 larger. Thus the two assemblies interferewith each other and the torsional stiffness constant in this rotationaldirection is significantly increased (by a factor of about 6) due to theinterference. Operation of the driveshaft in the torsionally stiffregion with enhanced fidelity is found to be obtainable by adding atorsional load to the distal end of the rotating assembly of catheter.The importance of rotational fidelity and details of how it is achievedwarrant further discussion.

For ultrasound imaging systems, the relative position of the ultrasoundtransducer must be accurately known at all times so that the returnsignal can be plotted properly on the display. Any inaccuracy inposition information will contribute to image distortion and reducedimage quality. Because, in the preferred embodiment, positioninformation is not measured at the distal tip of the catheter, butrather from the drive shaft at the proximal end, only with a torsionallystiff and true drive shaft can accurate position information and displaybe obtained.

Furthermore, it is recognized that any drive shaft within a cathetersheath will have a particular angular position which is naturallypreferred as a result of small asymmetries. Due to this favoredposition, the shaft tends, during a revolution, to store and thenrelease rotational energy, causing non uniform rotational velocity. Thisphenomenon is referred to as "mechanical noise" and its effect isreferred to as "resultant angular infidelity" for the balance of thisexplanation.

According to the present invention, use is made of the fact thatsuitably designed concentric coils interfere with each other, as hasbeen mentioned previously. When twisted in one direction, the outerlayer will tend to expand and the inner layer contract thus resulting ina torsional spring constant which is equal only to the sum of the springconstants of each of the two shafts. When, however, twisted in theopposite direction, the outer layer will tend to contract while theinner layer will expand. When interference occurs between the inner andouter layers the assembly will no longer allow the outer coil tocontract or the inner to expand. At this point, the torsional springconstant is enhanced by the interference between the shafts and thetorsional spring constant is found to become five or ten times greaterthan the spring constant in the "non-interference" mode.

Referring to FIG. 9, the relationship between torque and angulardeflection for such a coil assembly is shown, assuming one end fixed andtorque applied at the opposite end. `Y` represents mechanical noise; `Z`resultant angular infidelity; `T` the interference point; the slope ofthe line `U`, the torsional spring constant (TSC) without interference(i.e., the sum of the torsional spring constant of each of the twocoils); and the slope of the line `V`, the TSC with interference. Thus,TSC is shown to increase dramatically at the interference point.

Referring to FIG. 10, by pre-twisting the shafts relative to one anotherand locking their ends together in a pre-loaded assembly, theinterference point is moved to be close to the rest angle and resultantangular infidelity, Z, is reduced in the given direction of rotation.

To improve upon this effect even further, dynamic frictional drag isintentionally introduced at the distal end of the shaft to raise thelevel of torque being continually applied to the system. This ensuresoperation of the shaft in the region of the high torsional springconstant or "interference" mode throughout its length, producing arotationally stiffer shaft. This is shown in FIG. 11, where `W` isdynamic load and `X` is the region of operation. The use of such dynamicdrag is of particular importance in certain catheters of small diameter,e.g. with outer diameter less than about 2 mm.

To form inner coil 28, four individual wires are simultaneously woundaround a mandrel of about 0.5 mm outer diameter. The free ends of thiscoil are fixed, and then four wires are wound in opposite hand directlyover this coil to form the outer coil 26. The wires are wound undermoderate tension, of about 22.5 gm/wire. After winding, the coils arereleased. The inner mandrel, which may be tapered or stepped, or have aconstant cross-sectional diameter, is then removed. The wire ends arefinished by grinding. One end is then soldered or epoxied to fix thecoils together for a distance of less than 3 mm. This end is held in arigid support and the coils are then twisted sufficiently, e.g. 1/2turn, to cause the outer coil to compress and the inner coil to expand,causing the coils to interfere. The free ends are then also fixed.

The coil assembly 18 is generally formed from wires which provide a lowspring index, that is, the radius of the outer coil 26 musket be notmore than about 2.5 to 10 times the diameter of the wires used in itsconstruction. With a higher index, the inner coil may collapse. Themulti-filar nature of the coils enables a smaller diameter coil to beemployed, which is of particular importance for vascular catheters andother catheters where small size is important.

After the coil assembly is completed, coaxial cable 32 is insertedwithin the inner coil. The cable may be silver-coated on braid 36 toenhance electrical transmission properties. It is also possible to usethe inner and outer coils 26, 28 as one of the electrical conductors ofthis cable, e.g. by silver coating the coils.

Referring back to FIGS. 3 and 5, to form transducer 10, wire 42 issoldered to either side of electrically conducting sleeve 29 formed ofstainless steel. Wire 44 is inserted into a sound absorbent backing 48which is insulated from sleeve 29 by insulator 72. Piezoelectric element46 of thickness about 0.1 mm is fixed to backing 48 by adhesive andelectrical connection 74 is provided between its surface and the end ofsleeve 29. Thus, wire 42 is electrically connected to the outer face ofpiezoelectric element 46, and wire 44 electrically connected to itsinner face. Spherical lens 52, formed of acoustic lens materials isfixed to the outer surface of element 46.

Referring to FIGS. 4 and 7-7d, the completed drive shaft 18 andtransducer 10 are inserted into disposable catheter sheath 12,positioning transducer 10 within acoustically transparent dome element25, with liquid filling the internal open spaces. The catheter thusprepared is ready to be driven by the drive assembly; see FIG. 8.

During use, rotation of drive shaft 18, due to exposure of the helicalsurface of the outer coil to the liquid, tends to create helicalmovement of the liquid toward the distal end of the sheath. This tendsto create positive pressure in dome element 25 which reduces thetendency to form bubbles caused by out-gassing from the various surfacesin this region.

As has been mentioned, it is beneficial to provide added drag frictionat the distal end of the rotating drive shaft 18 to ensure operation inthe torsionally stiff region of the torsional spring constant curve. Itis found that this may be done by simply necking down the distal portionof the catheter sheath 12, as shown in FIG. 4 to provide a relativelytight clearance between the distal portion of the shaft 18 and the innersurface of the sheath, to impose the desired degree of viscous drag. Asan alternative, the dynamic drag may be provided by an internalprotrusion in catheter sheath 12 to create a slight internal frictionagainst drive shaft 18.

A preferred acoustic catheter is constructed so that it may be preformedprior to use by standard methods. Thus, if the investigator wishes topass the catheter through a known tortuous path, e.g., around the aorticarch, the catheter can be appropriately shaped prior to insertion. Suchpreformation can include bends of about 1 cm radius and still permitsatisfactory operation of the drive shaft.

Electronics

FIG. 12 is a block diagram of the electronics of a basic analogultrasound imaging system used with the acoustical catheter. The motorcontroller (D) positions the transducer B for the next scan line. Thetransmit pulser (A) drives the ultrasound transducer. The transducer (B)converts the electrical energy into acoustic energy and emits a soundwave. The sound wave reflects off various interfaces in the region ofinterest and a portion returns to the transducer. The transducerconverts the acoustic energy back into electrical energy. The receiver(C) takes this wave-form and gates out the transmit pulse. The remaininginformation is processed so that signal amplitude is converted tointensity and time from the transmit pulse is translated to distance.This brightness and distance information is fed into a vectorgenerator/scan converter (E) which along with the position informationfrom the motor controller converts the polar coordinates to rectangularcoordinates for a standard raster monitor (F). This process is repeatedmany thousands of times per second.

By rotating the transducer at 1800 rpm, repeated sonic sweeps of thearea around the transducer are made at repetition rate suitable for TVdisplay, with plotting based upon the rotary positional informationderived from the proximal end of the device. In this way a real timeultrasound image of a vessel or other structure can be observed.

We have found that within a blood vessel imaging system a focal point ofbetween 1 and 7 mm is suitable and that a frequency of 15 to 40 MHzprovides good resolution of vessel features in a practical manner.

Use

As mentioned above, the acoustical imaging catheter may be introduced bystandard techniques, preferably by percutaneous insertion, into anydesired blood vessel. Alternatively, it can be introduced directly intoa body cavity or body tissue such as an organ. Due to its rotationalfidelity, the device provides a relatively high quality, real time imageof blood vessel tissue and allows ready diagnosis of disease states suchas occlusion or dyskinesia. The acoustic properties of various tissuescan also be discerned to allow more accurate diagnosis. It is alsopossible to form 3-dimensional images using appropriate computersoftware and by moving the catheter within the blood vessel. The deviceis also useful in angioplasty therapy to determine the nature andgeometry of intravascular protrusions. This device may be combined withexisting optical devices to provide a device having an ultrasonicvisualizing probe and a laser ablating ability. The device may also beused in diagnosis of, e.g., esophageal tumors or prostate carcinomas, bypassing the catheter through the anus, urethra, trachea, or esophagus.The catheter is also useful for valvuloplasty by insertion through acardiac valve. Further, in non-medical areas, the device is useful forany inaccessible passages which are fluid filled, and thus transmitsound waves.

Selectable Catheter Sheaths

A wide variety of novel disposable catheter sheaths can be substitutedfor catheter sheath 12 and used in the system.

FIG. 13 and 13a show a flexible, disposable catheter sheath 12a that isconstructed like sheath 12 and has, in addition at its distal tip, afloppy guide wire 80 which is useful for guiding the ultrasound devicethrough a valve such as of the heart. The guide wire is constructed of aclosely wound wire coil 82 and an internal safety wire 84 for addedstrength. Wire 84 is welded to the distal tip of coil wire 82 and itsproximal end is bent over within dome 25 and securely anchored withepoxy cement. In another embodiment, the safety wire extends through aseparate lumen of the catheter sheath to a securing point at theproximal end of the catheter. In addition to its guiding function, coil80, with suitable variation of length and stiffness, is useful insupporting and steadying the free end of the ultrasound device duringaxial movement of the catheter to improve its imaging capability; seee.g. FIGS. 30-30c.

FIG. 14 shows sheath 12b having needle 86 securely anchored to the tip,useful for impaling a surface, such as that found in the interior of theheart, and temporarily anchoring and steadying the ultrasound device ina fixed position. In another embodiment, it too can have a safety wireextending to a proximal securing point. This acoustic catheter may beintroduced through an introducing catheter. In another embodiment, theneedle can be retracted during introduction.

FIG. 15 shows another flexible, disposable sheath 12c 4that isconstructed so that the sonolucent (acoustically transparent) portion24a is spaced from the distal end instead of at the end. The extension12x beyond the window 24a may be of the same flexible catheter materialas the main body of the sheath or of a different, e.g. softer material,and may be either open, so that fluids may pass through it, or closed,so that no fluids pass through. The distal extension of the cathetersheath can serve to stabilize the lateral position of the transducerduring axial movement of the catheter during imaging.

FIG. 16 shows a catheter sheath 12d on which is mounted, over thetransducer area, a dilatation balloon 55 such as is commonly used forangioplasty. The balloon is adapted to be pressurized with liquid, suchas water, through the same lumen that holds the ultrasound imagingdevice, via an inflation opening in the wall of the catheter sheath.This catheter is used to open a clogged, stenotic or narrowed passage inthe body, while simultaneously measuring the progress of the dilatationprocedure with the ultrasound images. Another embodiment with a suitableballoon may be used to center or position the ultrasound device securelywithin a body passage or cavity and maintain its position away from afeature of interest, for instance for imaging a wall of the heart. Theballoon in its collapsed or unpressurized state is easily inserted priorto positioning and may be accurately positioned by use of ultrasoundimaging during initial placement. In other embodiments a separate lumenis provided for inflation of the balloon and/or the balloon is spacedfrom the distal end of the catheter.

Referring to FIG. 17, a plan view of a preferred embodiment of anacoustic imaging balloon dilatation catheter system is shown. The system120 includes a boot member 122 including a ferrule member 124 at itsproximal end, constructed to enable electrical and mechanicalconnection, as discussed for example with respect to FIGS. 8-8a, to theacoustic imaging control system, as discussed for example with respectto FIG. 1, for transmitting rotary power and control signals to theacoustic imaging transducer held within the balloon catheter sheath 139near balloon 140 and for receiving acoustical image signals from thetransducer to enable monitoring and control of the dilatation process,as will be further described below. The proximal end of the apparatusfurther includes a seal 126 (FIG. 17d) which enables intimate butrelatively frictionless contact with the portion of the rotating driveshaft, and will also be further discussed below.

The catheter apparatus may be sized for use in various body cavities andapplications such as the coronary arteries, peripheral arteries such asthe iliac and femoral artery, the extremities, the esophagus, prostateand for valvuloplasty. In a preferred embodiment, shown in FIGS. 17-17cwhich may be of use in the peripheral arteries, for example, or the caseof a dialysis shunt, a 6 F sheath 128 extends a distance of L₁, about 30cm from the end of the seal 126 to a "Y" double flare compressionfitting 130. Fitting 130 includes a side arm 132 for introduction ofinflation fluid such as water or saline by means of a screw syringe 134for inflation of balloon 140 near the distal end of the catheter 139.The side arm 130 further includes inner passageways for control wires(not shown) within the balloon for controlling a heating means enablingheating of the inflation fluid for the purpose of heated balloonangioplasty. The heater control wires may be passed, for example,through conduit 136 to heater control module 138.

Extending distally from the compression fitting 130 is catheter bodysheath 139 which has an outer diameter of 4.8 F and extends a distanceL₂ about 92.5 cm to the center of the balloon 140. The catheter may beadapted to track a guide wire 152 which passes through a sonolucentsaddle member 159 beneath the balloon and out of a distal extension 157of the catheter, distal to the balloon. Also distal to the balloon isself-sealing septum tip 142 enabling introduction of saline or anotherfluid for purging the balloon of air bubbles that might impair acousticimaging. Such a self-sealing septum is described in U.S. Pat. No.5,002,059, the entire contents of which are hereby incorporated byreference. The length of the system 120, from the end of the ferrule tothe center of the balloon is L₃, about 132.5 cm and the length from theseal 126 to the center of the balloon is L₄, about 127.7 cm. Thecatheter 139 extends distally from the center of the balloon a distanceL₅, about 3 cm. The balloon length, L₆, is about 4 cm (inflated diameterabout 7-8 mm). The extension 157 distal to the balloon is L₇, about 1.5cm. The catheter length is L₈ about 95 cm.

Referring to FIG. 17a the distal end of the catheter is shown in partialcross section with the balloon deflated and inflated (phantom). Arotating ultrasound transducer 146 having a coil form drive shaft 141,as discussed herein above, is positioned on the central axis A of thecatheter sheath 139 at a position corresponding to the inflatabledilatation balloon 140. The catheter sheath 139 forms a sonolucent guidefor the transducer 146 and drive shaft. The catheter sheath is formed ofa thin (0.005 to 0.007 inch) sonolucent material such as polyethylene toprovide sufficient guidance for the drive shaft and transducer withoutcausing excessive attenuation of the ultrasound signal emitted by thetransducer. The catheter body material, the balloon material, and theguide-wire saddle are in general selected to be sonolucent and have anacoustic impedance substantially matched to the body fluid, e.g., blood,to which the catheter is exposed, to minimize attenuation of theacoustic signals emitted and received from the transducer. Polyethyleneis advantageous in that it has an acoustic impedance that substantiallymatches blood and saline, it is capable of withstanding high dilatationpressures and is only slightly elastic, enabling a reliable ballooninflation diameter. An advantage of the present system, which allowsobservation of balloon inflation during dilatation, is that balloonmaterials with some elasticity may be employed without danger ofover-inflation within a lumen since the operator can suspend inflationin response to the acoustic image at any time during treatment. It willbe understood that the catheter may be formed having sonolucent regionscorresponding to the location of the transducer while the rest of thecatheter is not sonolucent, e.g., made of thicker material. Fluidcommunication between the balloon and the catheter is provided throughport 151 to equalize the fluid pressure encountered during dilatationbetween the balloon and within the catheter to reduce the risk ofcollapse of the typically thin, sonolucent catheter and subsequentundesirable binding of the driving shaft which rotates the transducer,when the balloon is inflated at relatively high pressures, e.g., over100 psi for balloon angioplasty procedures.

The dilatation balloon 140 which is preferably polyethylene, asdiscussed, may be mounted at its ends 147, 148 over the guide-wiresaddle by, for example, melt-sealing. The balloon may also be secured tothe saddle by clips or the like as conventionally known. Prior tomounting the balloon in this area, the catheter is fitted with thesonolucent saddle 159 that extends under the area of the balloon andexits distally and proximally beyond the ends of the balloon. The saddleenables the use of a thin walled single lumen catheter body that issubstantially sonolucent. Further, the use of single lumen cathetersenables smaller catheter sizes to be employed, for example, 3 Fcatheters which can be used in coronary arteries. The saddle guide, asshown in cross section in FIG. 17b (taken along line 17b-17b of FIG.17a) and in FIG. 17c, is a tubular member disposed over the catheterhaving a bowed or stretched portion that creates a lumen in which theguide wire is placed. The saddle inner lumen is of sufficient clearanceto allow the catheter to track over a guide wire. The saddle ends 154,155 are angle cut and smooth edged to allow ease of entry of andguidance by the guide wire 152. The saddle is preferably formed ofpolyethylene having a wall thickness, T₁, of about 0.004 inch. Thethickness of the catheter body wall is T₂, and is about 0.007 inch. Theguide-wire diameter is D₁ about 0.018 inch and the drive shaft is of adiameter D₂ of about 0.045 inch. Referring back to FIG. 17a the guidewire passes through a side aperture 153 in the extension 157 of thecatheter 139 distal to the balloon, through the inner lumen of theextension 157 and a distal aperture 161. As indicated, the guide wire isexposed to the body lumen except for its passage through the saddle anddistal extension of the catheter. The saddle may be, for example,disposed around the entire circumference of the catheter along acontinuous length of the catheter corresponding to the length of theballoon in which case a port at a location corresponding to the port 151must be provided in the saddle, or optionally, the saddle may bedisposed around the entire circumference of the catheter only at itsproximal and distal ends, and partially about the circumferencetherebetween, enabling free flow from port 151.

The distal tip of the catheter is fitted with selfsealing septum 158 toallow introduction of saline or the fluid distally, forcing air bubblesthat might impair acoustic imaging and successful balloon inflationproximally. Alternately, the septum may be used as an air vent when aneedle is inserted, allowing the catheter to be filled with fluid from aside arm, in which case bubbles and undesirable air may be expelledefficiently and completely. The septum is more completely described inU.S. Pat. No. 5,002,059, incorporated supra.

For heating the balloon inflation fluid, annular electrical contacts143, 144 inside of balloon 140 are bonded directly to the cathetersheath 139. The contacts are positioned on either side of the transducer146 and are spaced apart approximately half the length of the balloon.The spacing from the respective ends of the balloon is approximately onefourth the length of the balloon, so that the balloon will heat evenly.The contacts 143 and 144 connect to opposite poles of current-controlled(constant current) radiofrequency power supply in the control module138. The catheter also includes a thermistor 145, located justproximally of the transducer 146 for measurements of balloontemperature. Wires for the contacts and thermistor (not shown) areenclosed within catheter sheath 139 along its length, and exit thecatheter through a lumen, which is accessible from inside of balloon140. The wires may also be provided in a separate lumen in a two-lumenguide catheter.

The control module includes an RF power supply that preferably operatesat 650 kilohertz, but can be at any frequency within the range of about100 kilohertz to 1 megahertz. The inflation fluid, while selected tohave resistive losses, has an electrical impedance low enough that itwill conduct the current supplied by RF power supply at voltages ofabout 100 volts or lower, so that there will be no arcing. A fulldescription of a suitable RF heated balloon system is described in U.S.application Ser. Nos. 07/404,483 filed Sep. 8, 1989 and 263,815 filedOct. 28, 1988now U.S. Pat. No. 4,955,377, the entire contents of bothsaid applications being incorporated herein by reference. Furthermore,it will be understood that other methods for balloon heating may beemployed.

Referring to FIG. 17d, proximally, the catheter is provided with astationary pressure tight shaft seal 126 that fits in intimate, butrelatively frictionless contact with a portion of the rotating driveshaft 162. The seal includes a ball seal 170 (available from Bal-sealEngineering Company, Inc., Santa Anna, Calif.), securely held in placeby a seal holder 172 (stainless steel or elastomer), which abuts thedistal end of the internal open area of the boot 122 and is held bycompression of the ferrule assembly 164 (although other means ofattachment such as injection molding are possible). The seal holder 172includes a retainer sleeve 174 that extends coaxially with respect tothe catheter 139. At the proximal end, within the ferrule, the driveshaft is held within a gland 178, preferably formed from hypotubing,which makes relatively frictionless contact with the ball seal 170,enabling rotation while preventing back flow of inflation fluid into theferrule. The ball seal, as shown, is an annular U-shaped member,including within the U a canted coil spring 179 (such that the axis ofeach coil is tangent to the annulus) that presses the legs 175, 177 ofthe seal radially. The outer leg 175 of the seal engages an extension176 of the seal holder, while the inner leg 177 of the seal engages thegland 178. The boot also includes a thin (few thousandths of an inch)metal sleeve 171 for additional sealing around the catheter.

The drive shaft 162 is modified in the sealing area 168 by impregnatingit with a thermoplastic material that fills the gaps in the individualwires to prevent flow of inflation fluid through the drive shaft innerlumen at typical inflation pressures of 100-120 psi or higher.Alternatively, the drive shaft may be sealed by impregnating it with aliquid that is hardenable, such as epoxy, and then covering that areawith a section of cylindrical metal, such as hypotube, in order to forma smooth, fluid tight seal capable of holding up to typical balloonpressure. It will also be understood that other sealing members may beused, e.g. an 0-ring.

Preparation of the device is accomplished by the following steps: ALeveen inflator is connected to the side arm. The side arm valve isopened and air is evacuated by suction. (Generally, the ballooncontracts in a folded manner which leaves air passages through theinterior of the balloon and prevents blockage of the passageway 151.) Ahypodermic syringe fitted with a small gauge needle and filled with afluid such as water or saline is then inserted through the distal tipseptum seal. Fluid is introduced until surplus exits the side arm, atwhich point the valve is closed, reducing the chances that air willre-enter the catheter. Alternately, the fluid may be introduced via theside arm when an air venting needle is inserted into the distal septum.

The catheter is then attached to the driving motor, (not shown), bymating the ferrule 124 with a mateable receptacle which connects theultrasound imaging electronics. Imaging can begin as soon as thedeflated balloon is inserted into a subject lumen. Because the balloonmaterial, saddle and sonolucent guide effectively transmit ultrasoundenergy, continuous imaging and monitoring of the subject lumen can beachieved.

By acoustic imaging, the device may be used to view the lumen andstenoses for diagnostic purposes, then the balloon may be positionedaccurately in any portion of the lumen such as a stenosis, anddilatation of the stenotic area may be performed using conventionaldilatation technique while the progress of treatment is monitored byultrasonic imaging and treatment is modified in response to the observedresponse of the tissue. Finally, after treatment, the balloon may bedeflated and the lumen imaged to observe the treated site or view othersites.

The modular construction enables the ultrasound imaging catheter'sability to be slidably inserted into a number of different types andstyles of catheter sheaths. The pressure and fluid tight connector thatis mounted distally to the location of the side arm connector enablesvarious catheters, such as those with balloons of different sizes, to beeffectively attached at the location of the side arm connector.

In operation, the acoustic imaging balloon catheter may be used to applypressure (and optionally, heat) to dilate a blood vessel by molding thewall or an obstructing material (like plaque). The blood vessel may be acoronary artery, or a peripheral artery such as an iliac, femoral,renal, carotid, or popliteal artery. The balloon catheter may also beuseful for dilatations in the biliary tract, esophagus or prostate.

Referring to Table I, below, preferred apparatus dimensions for varioustreatments are given.

                                      TABLE I                                     __________________________________________________________________________                      CATHETER                                                                             BALLOON                                                       DRIVESHAFT                                                                             DIAMETER                                                                             DIAMETER                                                                              BALLOON                                                                              CATHETER                                                                             EXTENSION                      APPLICATION                                                                            DIAMETER (BODY) (INFLATED)                                                                            LENGTH LENGTH LENGTH                         __________________________________________________________________________    Coronary .025"    3.0 F  2-3 MM  1.5 CM 140 CM .5 CM                          Arteries                                                                      Valvulo- .054"    6.2 F  14 MM   3 CM   110 CM 1.5 CM                         plasty                                                                        Peripherals                                                                            .040"    6.5 F  7-8 MM  4 CM   95 CM  1.5 CM                         (e.g.,                                                                        Iliacs,                                                                       femorals)                                                                     Extremities                                                                            .030"    4.8 F  4-6 MM  3 CM   95 CM  1.5 CM                         Esophogus                                                                              .054"    6.2 F  30 MM   4 CM   95 CM  1.5 CM                         and                                                                           Prostate                                                                      __________________________________________________________________________

Referring to FIGS. 18-18e, illustrating dilatation of a blood vessel, apercutaneous insertion is made with a needle, and a guide wire isintroduced into the blood vessel 112. The acoustic imaging ballooncatheter 110 follows the wire (for example employing the saddlearrangement discussed above) and is positioned at an obstruction in theartery such as a plaque deposit 114 (FIG. 18) by visualizing the innerwalls of the artery by acoustic imaging as the catheter is advanced.

While imaging continues, the balloon 116 is inflated to engage theplaque material 114 forming the obstruction (FIG. 18a). As pressureand/or heat is applied to the occluding material, the operator views theprogress of the dilatation to assure that the dilatation does not occurtoo rapidly, which may lead to the formation of cracks or flaps whichmay in turn lead to re-occlusion.

In the case of a heated balloon catheter, the pressure in the balloonmay be kept below the normal pressure required under ambient conditionsto widen the vessel to avoid cracking the plaque. Normal dilationpressure means the minimum pressure at which an unheated balloon causessubstantial dilation of the respective lumen. The low, sub-dilatationpressure used initially to engage the plaque material may be, forexample, about two atmospheres. In the case of angioplasty, normaldilation pressure is of the order of 5 to 10 atmospheres (varies withballoon size). The balloon self-forms around the irregular surfaces ofthe obstruction and provides a firm contact for efficient and eventransfer of heat. As the occlusion yields (by virtue of heating andgentle pressure as described below), the balloon expands to maintaineven contact with the surface. The operator monitors the dilatation byacoustic imaging to determine various physiological conditions andresponses to treatment.

With the balloon inflated to a low level of pressure and engaging theobstruction, the user may initiate the bi-polar heating between theelectrodes 143, 144 as discussed above, (e.g. by depressing a footswitch to start a heating program). Heat is dissipated into the fluidaccording to the formula P=I² R where P is the power that is dissipatedinto the fluid, I is the current that is passed through the electrodes,and R is the resistance of the fluid. The heat from the fluid isconducted across the balloon wall into the surrounding tissue 44. Thefluid will heat to the temperature set by the user to carry out atemperature algorithm. The temperature at the balloon surface rangesfrom 45°-90° C. and is typically from 50°to 70° C., sometimespreferably, around 60°-65° C.

While heating, the operator monitors the condition and physiologicalresponse of the vessel under treatment by acoustic imaging. When theobstruction is under certain conditions of heat and pressure, theheterogeneous plaque material (usually including fat, fibrogen, calcium)softens, resulting in a change in the allowable volume of the balloon ata given low pressure (preferably below the pressure needed to crack theobstruction).

In FIG. 18b, for example, the stenoses is observed by acoustic imagingto expand slowly as the occluding material elastically (reversibly)expands with gentle heating until, upon reaching a yield point at timecorresponding to the conditions of pressure and temperature at which theocclusion yields. Thereafter, the stenoses is observed by acousticimaging to yield at a higher rate as the occluding material yieldsplastically (substantially nonreversibly).

As shown in FIG. 18c, after observing the yield of the plaque byacoustic imaging, the operator determines the course of furthertreatment, which may include maintaining or slight changes intemperature or pressure of the balloon, to effect full dilatation of theartery where the continued treatment leads to full expansion of theballoon and artery at a time.

As illustrated in FIG. 18d, after the vessel has been fully dilated, thetemperature of the balloon is reduced, while the balloon remainsinflated. Recycling the temperature allows the material of theobstruction, the plaque, to be mold-formed by the balloon as it coolsand reconstitutes. The interior walls of the remodeled lumen are leftsmooth and with reduced chance of re-occlusion. The temperature isreduced while the balloon is inflated.

Finally, as illustrated in FIG. 18e, the balloon is deflated and removedfrom the body lumen. The operator then can observe the dilated vessel byacoustic imaging. Referring now to FIG. 19, in another embodiment of theacoustic imaging catheter device, the transducer 146 is positioned inthe distal tip extension of the balloon catheter and distal to theballoon. A sonolucent window located distal to the balloon allowsimaging to take place during the positioning of the balloon and aftertreatment. In this case, ultrasonic energy is not transmitted throughthe catheter sheath 190, balloon 191 or saddle 192 as in the previouslymentioned embodiments. After location and inspection of the area to betreated, the catheter is advanced a known amount, e.g. a fewcentimeters, (monitorable from outside the body) and the balloon isinflated. The dilatation is performed, and then the balloon iswithdrawn, allowing a post dilatation view of the region.

In other embodiments, the transducer may be positioned proximal to theballoon. These embodiments may be particularly useful for prostatedilatation where the balloon is to be positioned distal to the urinarysphincter to avoid dilation of the sphincter. By visualizing thesphincter by acoustic imaging with a transducer proximal to the balloon,the operator is assured that the balloon is distal to the sphincter.

Referring now to FIGS. 20-20b, other embodiments of the acoustic imagingcatheter device allow relative movement of the transducer and balloon sothat the ultrasound transducer may be positioned in any longitudinalposition in the balloon, or distal or proximal to the balloon, for anassessment, inspection of the body lumen and monitoring of the placementof the balloon, the dilatation procedure and then post-treatmentinspection. In FIG. 20, the drive shaft and transducer 146 may be slidaxially as indicated by arrows 195 to move the transducer, for example,continuously to positions between position I, proximal to the balloonand position II, distal to the balloon. A slide assembly 240 is providedincluding a housing 244 having a distal end which receives the cathetersheath 139 and drive shaft 145. The drive shaft contacts a pair ofoppositely arranged, relatively frictionless ball seals 245, 246 pressfit within the housing against an inner body extension 249 and thedistal end member 248 of the body which is threaded into the body 244.The ball seals engage a gland 250 as discussed with respect to FIG. 17d.The gland is attached to a thumb control 252, provided within the bodyto enable axial motion of the drive shaft to position the transducerwithin the catheter corresponding to regions within the balloon and inthe distal extension, both of which are sonolucent. For example, it maybe advantageous, as illustrated by the position of the transducer 146 inthe series of FIGS. 18-18e, to position the transducer in the distalextension of the catheter during insertion of the catheter to inspectand locate the region to be treated by the balloon, then retract thetransducer into a region corresponding to the balloon to observedilatation and finally, the transducer may be slid forward for posttreatment inspection of the lumen after balloon deflation.

The axially translatable transducer device further includes a carbonresistor 254 within the slide assembly housing, and contact means 258attached to the thumb control and in contact with the resistor. Probewires 256, 257 are connected to the resistor 254 and contact means 258to provide variable resistance between the probe wires as the thumbcontrol is slid axially, which is detected at detector 260, to providemonitoring of the axial position of the transducer. The thumb controlmay be hand actuated or controlled by automatic translator means 264which receives control signals from a controller 266. In preferredembodiments, the output from the detector 260 is provided to an analysismeans 268 which also receives the acoustic images from the transducercorresponding to various axial positions of the transducer within thecatheter body to provide registry of the images with the axialtransducer position on a screen 270. In preferred embodiments, thetransducer is slid axially, along a continuous length or at selectedpositions of the catheter body, for example, from the balloon to thedistal tip, and the analysis means includes storage means for storingimages along the length to reconstruct a three-dimensional image of thelumen along the axial length of transducer travel.

FIG. 20b shows an embodiment wherein the catheter includes a bellowsmember 280 to enable axial motion of the catheter body with respect tothe transducer.

In another embodiment of the acoustic imaging catheter device, theballoon is asymmetrical, either or both in shape and expansioncapability, and is mounted on a catheter shaft that is torquable, andcan then be positioned using acoustic imaging so that radially selectivedilatation is accomplished on the desired portion of the lumen wall bytorquing the catheter. As discussed above, the positioning, rupturing,stretching and compression of the lesion and surrounding tissue, and thedeflation of the balloon can all be monitored with cross-sectionalultrasonic images.

For example, multiple balloons may be used that are for example,separately heated to effect asymmetric heating. The correct orientationof the balloons in the lumen can be achieved and confirmed byobservation through acoustic imaging. Referring to FIGS. 21-22b aballoon catheter 200 comprises a catheter shaft 202 and at least twoballoons 204 and 206. Catheter shaft 200 passes through the length ofballoon 204. The proximal and distal ends of balloon 204 are tacked ontocatheter shaft 202 at locations adjacent the proximal and distal ends ofballoon 204. Catheter shaft 202 includes inflation and pressureequalization ports 207, 208 within balloon 204 through which fluidenters and exits balloon 204, and ports 210 and 212 through which fluidenters and exits balloon 206.

The fully extended diameter of each of the balloons 206 and 208, wheninflated, typically ranges from 2 millimeters for vascular procedures to20 to 35 millimeters for hyperthermia treatment of the prostate,esophagus or colon. The combined volume of the balloons ranges from 1/8cc for the smallest balloons to 100 cc for the largest balloons. Thewall thickness of the balloons 204 and 206 is about 0.001 inch. In someapplications, e.g. where the catheter 200 is being used in a bloodvessel, a guide wire 214, which can extend past the distal end of thecatheter, may be used to guide the catheter through the vascular systemor other luminal structures. The guide wire may also be passed through asaddle as discussed above, for example, with respect to FIG. 17a. Theexteriors of the balloons are coated with a non-stick coating having alow coefficient or friction, such as silicone or polysiloxane. Thenon-heated balloon may be covered with a coat of heat-insulatingmaterial or silver heat-reflective material thereby enhancing thetemperature difference between the heated balloon and the unheatedballoon.

Balloons 204, 206 are fillable with an electrically conductive fluidsuch as normal saline (0.9 percent NaCl in water), a conductiveradiopaque fluid, or a mixture of saline solution and a radiopaquefluid.

In an alternative construction of the embodiment shown in FIGS. 21-21b,balloons 204 and 206 may be replaced by a single, multi-segmentedballoon. Catheter shaft 202 passes through the length of one of thesegments. The other segment connects with catheter shaft 10 at thelocations of lumens 210 and 212.

Electrical contacts 218 and 220 which effect heating by RF powerdissipation, as discussed above are exposed to the fluid inside of oneof the balloons 204, but are not substantially exposed to the fluidinside of the other balloon 206. Within the catheter 200 is positioned acoil-form drive shaft 222 (phantom) having at its distal portion anacoustic transducer 224. The shaft is rotatable, enabling acousticimaging of the lumen to be treated for positioning of the catheter andballoons, monitoring treatment and post-treatment inspection of thelumen.

In FIG. 21a, the multiple balloon catheter is shown in cross-sectionalong lines B--B of FIG. 21. The catheter 202 includes a single lumen230 which rotatably supports the drive shaft 222 as discussed above.Inflation fluid for both balloons is passed through the lumen 230 andthe inflation ports 207, 208, 210 and 212 as described above. Thelocation of the heater contacts 218, 220 in balloon 206 results insubstantial heating of balloon 204, with only minor conduction of heatand RF power through the catheter body to balloon 206. Further detailsof a multiple balloon catheter adaptable to acoustic imaging arediscussed in U.S. Pat. No. 5,151,100.

FIG. 22 and 22a shows sheath 12e, similar to sheath 12, which isadditionally fitted with an eyelet 90 through a solid portion of the tipto allow the free passage of a guide wire 92 which is used to help guidethe catheter to a region of interest inside a passage of the body.

FIG. 23 shows sheath 12f having a two lumen construction. The largelumen contains the transducer and drive shaft while the small lumencontains a wire 94. As shown, wire 94 is a deflecting wire attached nearthe distal end, and is free to slide through its lumen under tensionapplied to ring 96 to cause the catheter to bend when pulled taut, thusproviding a measure of control of the orientation of the distal end ofthe acoustic catheter while negotiating the passages of the body or thelike. In another embodiment wire 94 may be a preformed stylet, which,when inserted through the second lumen, causes deflection of the tip.

FIG. 24 shows sheath 12g having a small hole 97 at its distal end toallow the passage of a fluid under pressure, such as saline or clotdissolving enzyme such as urokinase, or radiographic contrastenhancement fluids. By this device such fluids can be introduced underprecise guidance using the ultrasound imaging capability of thecatheter.

FIG. 25 and 25a show sheath 12h placed in a specially designed hollow,rigid, sharply pointed metallic trocar 98 similar to a lance, designedto be driven into the body and further into the tissue of an organ ofinterest, such as the liver or spleen, to provide ultrasound imaging ofan area where there is no natural passageway. A side-facing window 99 inthe distal region of the trocar tube allows the passage of ultrasoundenergy from and to the transducer to enable imaging to take place.Alternatively, a portion of the trocar (phantom, FIG. 25a) may be formedof sonolucent material, to form an ultrasonic window. The hollow trocartube serves further to prevent crushing or deformation of the ultrasoundcatheter under the considerable pressure required to drive the deviceinto solid body tissue. After ultrasound inspection the imaging cathetermay be withdrawn from this device and a biopsy device may then beinserted in its place with the advantage that the region from which thebiopsy is to be taken has been very accurately located by acousticimaging.

The acoustic imaging-trocar apparatus is useful, for example fordiagnosis of tumors in the liver. Typically liver cancer is firstevidenced by a number of very small tumors that are diffuse and randomlylocated making them difficult to visualize by external ultrasoundapparatus. By employing the acoustic imaging-trocar apparatus of thepresent invention early detection of cancerous tumors may beaccomplished by driving the ultrasound catheter inside the trocar intothe liver where small tumors are suspected or likely to be. By drivingthe catheter into the tissue, although there is no natural passageway,the operator can search for tumors in the field of view. When a tumor isfound the operator can remove the ultrasound imaging catheter and placewithin the trocar a biopsy sampling instrument such as forceps 284 tocollect a small portion of the tumor (FIG. 25b). The forceps jaws 283,285 are moveable from proximal portions as indicated by arrows 287 toopen and close the instrument to grasp a sample. Similar procedures maybe carried out in the breast, in searching for small tumors. In generalthe benign tumors are more or less encapsulated whereas cancerous tumorshave a diffuse edge therefore enabling a preliminary analysis of thetumor by acoustic imaging. In another embodiment, shown in FIG. 25c, thetrocar may include at its distal end, in the vicinity of the transducera radioactive pellet 286, for radiation treatment of tumors found byultrasonic imaging.

FIG. 26 shows flexible, disposable sheath 12i made of integral,thin-walled extruded plastic which is more or less sonolucent. Thisconstruction avoids the necessity of having a separate dome or windowattached to the distal end. The distal end is post formed (thinned, e.g.by drawing and blowing) after extrusion to provide the correct wallthickness dimension for best sonic transmission and mechanical strengthand may be sealed fluid tight at the tip.

FIG. 27 shows sheath 12j which is similar to sheath 12i of FIG. 26, andadditionally has an integral floppy tip made by continuing the drawingprocess to form a small diameter solid but flexible extension of thesheath beyond the sonolucent area; it can achieve certain of theadvantages of catheter 12a of FIG. 13 but without the additional cost ofadding a separate metal floppy guide wire.

FIG. 28 shows sheath 12k which is formed to have an inner end bearingsurface 101 at the distal tip for serving as an axial and radial bearingfor the rotating ultrasound transducer. This bearing is e.g. a smallspherical or conical formation. By applying an axial, distal thrust onthe shaft, and axial proximal tension on the catheter sheath, thisbearing action creates tension on the tapered area of the dome, thusmaintaining its shape by stretching, and allowing an even thinnermaterial to be used, to reduce loss of acoustic energy in the substanceof the window.

FIG. 29 and 29a show sheath 121 which is fitted with a keyed rotatingshaft that accepts the end of a similarly keyed ultrasound transducer,and acts as a power takeoff for driving a rotatable instrument such asthe atherectomy cutter 105, shown.

FIGS. 30-30c show a sheath constructed along the lines of sheath 12a ofFIG. 13, being used in guiding and penetrating through the movingopening of a human heart valve. It shows how the floppy guiding wireacts as a stabilizer and a centering device allowing the ultrasounddevice to be moved forward and withdrawn repeatedly and consistently, asis desirable for proper imaging of the valve before and aftervalvuloplasty.

FIG. 31 shows an integrally-formed catheter sheath having an acousticwindow 24i originally of the same extruded material as the body of thecatheter, the material of the window being modified to enhance itsacoustic window properties. In this embodiment the main body 12_(mb) ofthe sheath has wall thickness t of 0.4 mm and outer diameter D of 2 mm.The integral window 24_(i) has outer diameter D corresponding to that ofthe main body of the catheter and a modified wall thickness t₁ of 0.2mm. Any of these catheters may be additionally fitted with radiopaquemarkers either at the tip or the middle or both, designed to be visiblewhen seen under the fluoroscope while intraluminal ultrasound imagingtakes place. The markers are made of a metallic material that blocksX-ray radiation or a metal filled adhesive or epoxy is applied to thesurface, in a groove, or at the end of the device. Additionally themetal-filled epoxy may be used to seal the end of the device as well asprovide radiopacity.

Other embodiments are within the following claims.

We claim:
 1. A catheter for use within the body of a living being,comprisingan elongated tubular catheter member, and an ultrasound probecarried by said elongated tubular catheter member, said probe comprisinga flexible, axially elongated drive shaft and an ultrasound devicemounted on the distal end of said drive shaft arranged to directultrasonic signals toward an internal body structure, said elongatedultrasonic probe being constructed to rotate relative to said tubularcatheter member to generate acoustic images, said ultrasound devicebeing constructed and arranged to form ultrasound images of a portion ofsaid body of said living being, said elongated tubular catheter memberforming a closed passage surrounding said elongated ultrasonic probe andsaid ultrasound device, said elongated tubular catheter member having asmall hole located entirely distal of said ultrasound device, said smallhole having a diameter less than the outer diameter of said cathetermember and being constructed to permit passage of fluid under pressurethrough said closed passage surrounding said ultrasonic probe and saidultrasound device and out of said catheter through said small hole, intosaid body of said living being.
 2. The ultrasound-guided fluid passagecatheter of claim 1, wherein said fluid is saline.
 3. The catheter ofclaim 1, wherein said small hole is located at the distal extremity ofsaid catheter member.
 4. The catheter of claim 3, wherein said smallhole is concentric with the longitudinal axis of said catheter member.5. The catheter of claim 1, wherein said ultrasound device is anultrasound transducer.
 6. The catheter of claim 1, wherein saidultrasound device has an outer diameter substantially corresponding tothe outer diameter of said drive shaft.